Low income is a risk factor for 'catastrophic' amputation after knee joint replacement

April 30, 2019

April 30, 2018 - Above-knee amputation (AKA) is a rare but severe complication of deep infection after knee replacement surgery. Low-income patients are at increased risk of this catastrophic complication, reports a study in Clinical Orthopaedics and Related Research® (CORR®), a publication of The Association of Bone and Joint Surgeons®. The journal is published in the Lippincott portfolio by Wolters Kluwer.

Race and sex do not affect the risk of AKA after periprosthetic joint infection (PJI), according to the new research, led by Shyam Brahmabhatt, MD, of Rothman Orthopaedic Institute, Philadelphia. In an accompanying 'Take 5' interview, Dr. Brahmabhatt and CORR Senior Editor M. Daniel Wongworawat, MD, discuss the new evidence on how social factors may influence health outcomes and access to care for patients with complications after knee joint replacement surgery.

Income and Insurance Status Affect Amputation Risk in Patients with Infected Knee Prostheses

Using data from a nationally representative hospital database (Nationwide Inpatient Sample), the researchers identified approximately 33,000 patients diagnosed with PJI after knee joint replacement surgery between 2010 and 2014. Referring to infection developing around the artificial joint implant (prosthesis), PJI itself is a serious complication, usually requiring further surgery.

In a small number of cases, treatment of the infection is unsuccessful, requiring amputation of the limb at a level above the knee. Of the 33,000 patients with PJI, about three percent had AKA. The researchers analyzed risk factors associated with AKA, focusing on socioeconomic measures (income and insurance status), race, and sex.

Socioeconomic factors were significantly related to AKA risk, even after adjustment for the patients' health status and other characteristics. Patients living in areas (based on ZIP code) in the lowest one-fourth of income were 58 percent more likely to sustain an AKA, compared to those living in the highest-income areas.

Patients on public insurance were also at higher risk. Compared to those with private insurance, the odds of AKA were 94 percent higher for Medicare patients and 86 percent higher for Medicaid patients.

The risk of AKA was not significantly different for black compared to white patients. That's an important finding, as previous studies had suggested that black race might be a risk factor for AKA after knee replacement surgery. Risk was also similar for men compared to women.

Because of the large number of patients who undergo knee joint replacement and the poor functional outcomes associated with AKA, it is essential to understand the risk factors for this devastating complication. A recent study in CORR® reported that the occurrence of AKA due to PJI more than doubled over a 15-year period.

The researchers were surprised to find that where the patient lived had such a major impact on AKA risk. "While ZIP code may not be a perfect measure of socioeconomic status, it is associated with the level of resources that may be available to people living in that area," says Dr. Brahmabhatt in his 'Take 5' interview. The researchers call for further studies to explore strategies to prevent PJI - particularly in patients from low-income areas.

Drs. Brahmabhatt and Wongworawat discuss the findings in the context of multidisciplinary efforts to reduce health disparities and inequalities in care. "The message that I would impart is that upholding the principles of equity, social justice, and ensuring community health are important for all physicians," says Dr. Brahmabhatt. "It's important to remember that all specialties work together as a team to fulfill vital roles in helping our patients towards that goal."
-end-
Click here to read "Socioeconomic Status is Associated with Risk of Above-knee Amputation After Periprosthetic Joint Infection of the Knee"

DOI: 10.1097/CORR.0000000000000634

About CORR®

Devoted to disseminating new and important orthopaedic knowledge, Clinical Orthopaedics and Related Research® is a leading peer-reviewed orthopaedic journal and a publication of The Association of Bone and Joint Surgeons®. CORR® brings readers the latest clinical and basic research and informed opinions that shape today's orthopaedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system.

About the Association of Bone & Joint Surgeons®

The mission of The Association of Bone and Joint Surgeons® is to advance the science and practice of orthopaedic surgery by creating, evaluating, and disseminating new knowledge and by facilitating interaction among all orthopedic specialties. Founded in 1947 as the "American Bone and Joint Association," ABJS membership is offered by invitation only to orthopaedic surgeons who have been certified by the American Board of Orthopaedic Surgery.

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer reported 2018 annual revenues of €4.3 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 18,600 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

Wolters Kluwer Health is a leading global provider of trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning and research and clinical intelligence. For more information about our solutions, visit http://healthclarity.wolterskluwer.com and follow us on LinkedIn and Twitter @WKHealth. For more information, visit http://www.wolterskluwer.com, follow us on TwitterFacebook and LinkedIn.

Wolters Kluwer Health

Related Infection Articles from Brightsurf:

Halving the risk of infection following surgery
New analysis by the University of Leeds and the University of Bern of more than 14,000 operations has found that using alcoholic chlorhexidine gluconate (CHG) halves the risk of infection in certain types of surgery when compared to the more commonly used povidone-iodine (PVI).

How plants shut the door on infection
A new study by an international team including University of Maryland scientists has discovered the key calcium channel responsible for closing plant pores as an immune response to pathogen exposure.

Sensing infection, suppressing regeneration
UIC researchers describe an enzyme that blocks the ability of blood vessel cells to self-heal.

Boost to lung immunity following infection
The strength of the immune system in response to respiratory infections is constantly changing, depending on the history of previous, unrelated infections, according to new research from the Crick.

Is infection after surgery associated with increased long-term risk of infection, death?
Whether experiencing an infection within the first 30 days after surgery is associated with an increased risk of another infection and death within one year was the focus of this observational study that included about 660,000 veterans who underwent major surgery.

Revealed: How E. coli knows how to cause the worst possible infection
The discovery could one day let doctors prevent the infection by allowing E. coli to pass harmlessly through the body.

UK study shows most patients with suspected urinary tract infection and treated with antibiotics actually lack evidence of this infection
New research presented at this week's European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Amsterdam, Netherlands (April 13-16, 2019) shows that only one third of patients that enter the emergency department with suspected urinary tract infection (UTI) actually have evidence of this infection, yet almost all are treated with antibiotics, unnecessarily driving the emergence of antimicrobial resistance.

Bacteria in urine doesn't always indicate infection
Doctors should think carefully before testing patients for a urinary tract infection (UTI) to avoid over-diagnosis and unnecessary antibiotic treatment, according to updated asymptomatic bacteriuria (ASB) guidelines released by the Infectious Diseases Society of America (IDSA) and published in Clinical Infectious Diseases.

Subsidies for infection control to healthcare institutions help reduce infection levels
Researchers compared three types of infection control subsidies and found that under a limited budget, a dollar-for-dollar matching subsidy, in which policymakers match hospital spending for infection control measures, was the most effective at reducing the number of hospital-acquired infections.

Dengue virus infection may cause severe outcomes following Zika virus infection during pregnancy
This study is the first to report a possible mechanism for the enhancement of Zika virus progression during pregnancy in an animal model.

Read More: Infection News and Infection Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.